Mission moving in: Haywood Regional facing battle over home turf

Mission Health plans to expand its presence in Haywood County with a large medical complex housing doctors’ offices and a line of healthcare services.

The move is unwelcome competition for Haywood Regional Medical Center. But to Mission, it’s a reflection of “the strong preference that many Haywood County residents” have already shown by traveling to Asheville.

Mission paid $1.375 million for a 23-acre site off Hospital Drive, where many of the doctors’ offices and medical facilities are clustered in Haywood County.

The announcement by Mission came just two weeks after Haywood Regional Medical Center was bought by a large national hospital network. After several years of barely breaking even — a plight shared by small hospitals everywhere — Haywood Regional determined the deeper pockets and clinical expertise of Duke LifePoint were needed to remain viable and strong.

Officials with Duke LifePoint and Haywood Regional Medical Center would not do an interview for this article but provided a written statement.

In the past, when Mission has made forays into Haywood — from Mission doctors holding rotating office hours here to billboards targeting Haywood residents on Interstate 40 — it has been criticized as encroaching on Haywood’s turf. When competing against Mission, Haywood Regional has portrayed itself as the home team and appealed to locals’ sense of loyalty as part of its pitch to keep patients from going to Mission.

But Ron Paulus, president and CEO of Mission Health, said the patients came to Mission first, and Mission is answering that demand for choice.

“We do surveys of all of our counties all the time and ask them, ‘Where do you prefer to get your care?’” Paulus said. “It is not like nobody has ever come here. We have large numbers of people who already come here.”

Mission Hospital in Asheville saw 9,000 patients from Haywood County last year — accounting for one-third of Haywood residents seeking hospital care. Haywood Regional captures less than two-thirds of the Haywood market share, according to hospital reporting data. Those 9,000 Haywood residents account for about 7 percent of Mission’s total patient load of 146,000 last year.

Others could also prefer to use Mission if not for the travel.

“We know that not all patients who desire Mission care can access it easily there,” Paulus said.

Now, Mission is bringing that care closer to the patients who have already shown a preference for Mission, Paulus said.

The “care close to home” line has often been used as a tagline by Haywood Regional Medical Center and has been adopted by the new owners, Duke LifePoint.

“We believe that the residents of the community deserve to have access to the best possible, most comprehensive care close to home,” Duke LifePoint said in a written statement.

But Mission has challenged the assumption that Haywood Regional is the only one entitled to provide “care close to home” for Haywood residents.

“If we can contribute to keeping care close to home, that is terrific,” Paulus said.

Mission’s expanded footprint in Haywood is sending the message that it, too, considers Haywood part of its market and won’t sit on the sidelines.

Paulus said Mission values a collaborative relationship with the Haywood medical community.

“It is not possible to be collaborative when the other party doesn’t want to be. I am not noting LifePoint in that scenario, but it takes two people to dance. You can’t have one interested party and not another,” Paulus said.

In response to accusations that Mission is being overly competitive, Paulus cited Duke LifePoint’s publicly stated strategy to recapture Haywood patients who have drifted to Mission. To Paulus, it seems Duke LifePoint is the one signaling its intentions to compete with Mission.

“We want to make Haywood Regional Medical Center all it can be, so that residents can receive the care they need right here, rather than having to leave this community,” Duke LifePoint said in a written statement.

That is indeed a hallmark of LifePoint at its 65 hospitals around the country, most of them smaller community hospitals. Its modus operandi: to grow the community hospitals to profitability by providing more services and doctors, and in turn reclaim local market share lost to larger urban hospitals nearby.

LifePoint made that pledge to Haywood Regional during a reception earlier this month celebrating the hospital’s new ownership.

“We have to do things extremely well, perhaps even better than what they get somewhere else, because every small hospital fights this perception of there’s something better somewhere else,” Jeff Seraphine, president of LifePoint’s eastern group of hospitals, said in an interview as the reception opened.

Since the recent sale of Haywood Regional and WestCare in Jackson and Swain counties to the national, for-profit Duke LifePoint, Mission has been quick to trump its status as the “only locally owned, locally governed, nonprofit” health care network.

Paulus referred to Duke LifePoint as a newcomer in the healthcare landscape of Western North Carolina, meanwhile citing Mission’s service to patients in the region for over a century. Paulus added that Mission has a few hundred employees who live in Haywood, making Mission a local employer here as well.

Primary care doctors are a critical front-line for hospitals. Patients go to their family doctors first for whatever ails them. From there, they have batteries of tests and labs ordered, are referred to specialists, scheduled for outpatient procedures or admitted into a hospital.

The first point of primary care contact for patients can theoretically steer the trajectory of medical services they need. But Paulus said there is no presumption that doctors affiliated with Mission would necessarily refer patients within Mission Health’s network.

First of all, it is illegal for a hospital to require or even pressure doctors to favor a particular hospital or specialist network when making referrals.

“We believe that all physicians should refer to the most talented, thoughtful and patient-centered caregiver. That should be done in dialog with the patient,” Paulus said.

Mission Health has had a small outpatient center in Haywood County for several years, led by Dr. David Mulholland, a fulltime primary care physician affiliated with Mission. The existing center offers limited imaging and lab services, and specialty care on a rotating basis. Mulholland’s practice, Haywood Family Medicine, will be moving to the new site once completed.

“It’s wonderful to see the next stage of evolution for primary and specialty care in Haywood County with this announcement,” said Mulholland in a written statement.

Mission’s plans call for a 30,000-square-foot medical building with primary care doctors and specialists, but the exact specialties are still being determined, Paulus said. The goal is to have a team of doctors based exclusively in Haywood, as well as some specialists based in Asheville who would hold regular office days in Haywood. It will also house expanded imaging and lab services along with new virtual care capabilities, known as telemedicine.

Although Duke LifePoint’s written statement said it was unaware of Mission’s plans, Paulus said Mission informed Duke LifePoint last week before sending out a press release announcing the expansion.

Why expand?

Paulus cited a few factors that led Mission to expand its healthcare services in Haywood County. One is a shortage of primary care physicians.

“We did an extensive study of primary care in the 18-county area we serve here in Western North Carolina. We found most are well under where we should be. Haywood rose to the top,” Paulus said.

Haywood County has 15 primary care physicians, known as family doctors, according to a survey of primary care offices in the county and internet listings.

Paulus declined to postulate why Haywood Regional has not recruited more primary care physicians to the community itself, or why he believes Mission will be any more successful in solving the shortage.

“There has certainly been a long time when it could have been done. It is not about why they did or why they didn’t, or why they will or why they won’t. It is about, ‘How can we support this region in the way we have for more than a century,’” Paulus said.

Perhaps the biggest reason for ramping up its presence in Haywood is Mission’s larger philosophy of what patient-centered healthcare should look like in the future.

“We are migrating our focus from episodic, acute hospital care into a much more robust population health management system,” Paulus said.

Paulus has been a vocal champion of a new model of healthcare known as “accountable care organizations,” in which a hospital and its affiliated team of physicians work in tandem to be accountable for the health of a given population of people.

The accountable care model is becoming the preferred approach to providing medical care in America as the nation seeks ways to make healthcare more efficient and affordable.

Mission can’t realize that goal without frontline medical providers on the ground committed to a seamless system, with a focus on preventative care rather than treating patients once a disease becomes acute, Paulus said.

“We have an ecumenical model,” Paulus said. “We don’t feel like all the doctors have to be Mission affiliated. But they do need our mindset, which is all about the patient first and keeping people out of the hospital, not putting them into the hospital.”